Tees LPC Meeting
29th January 2014. 09.00-17.00
Marton Pharmacy
MINUTES
Attendees:
Paul Pendergood (PP), Elaine Ballentyne (EB), David Jarvis (DJ), John Welsh (JW), Sarah Ramshaw (SR), Pete Horrocks (PH), Sandie Hall (SH), Michael Maguire (MM), Brent Foster (BF), Geraint Morris (GM)
Apologies:
Jay Badenhorst (JB), Helen Lynch (HL), Mark Burdon (MB), Brian Roe (BR), Lorraine Crawford (LC)
Chairs Introduction:
Jay Badenhorst is currently on leave, therefore, PH chairing meeting
Minutes of Previous Meeting:
Agreed as an accurate review of events.
Task and finish group still to be formed and moved forward. MM will update during LPN overview later in agenda.
Patient Dignity and Patient Choice. Healthwatch have not sent through the questionnaire but have visited Community Pharmacy.
Nominations: Self stamped addressed envelopes to be sent with voting form. SH co-ordinating the process. There will be an independent vote.
Doodle.
PSNC:
MB sent an overview to be sent out with minutes. Regional LPC raised, brief update on regional issues outlined..
Flu Region: of vaccines done 30% have been customers who had a vaccination in the past in pharmacy. 60% chose pharmacy over GP. 10% new patients.
Psychological Therapies:
Attendance from Amanda Farley (MIND), Ann Drummond (Alliance) on behalf of IAPT
Introductions around the room.
Information about the history of IAPT services – 1997 new labour brought in PCTs, Alliance and Mind commissioned to provide psychological and counselling services. Primary care services were inconsistent across Tees. 2007 IAPT was developed – improve the mental health and wellbeing of the population you will then cut welfare costs. 2 pilot sites Newham and Doncaster were developed. Outcome low level interventions were successful as well as telephone contact were seen. North Tees were rolled out as the second wave pilot sites. National rollout then occurred with psychological wellbeing practitioner roles developed. These were to facilitate self help in the mild to moderate mental health areas. Teesside now has training provider status on CBT and low level intervention. Tees time to talk was a collaborative group to run the project across the area. 70 trainees recruited and set up via IAPT principles. Referral from GP, triage then support. AQP route of provision of the service now.
List now MIND. Alliance. Mental Health Matters, Mental Health Concern, Starfish, TEWV
Assessment of patients within 2-5 working days. 10 days to get in low level of intensity. 28 days if more complex need. IPAT includes counselling, EMDR, CBT, Couples depression counselling (funded by RELATE). Rooms may be an issue.
Clients can self refer, GPs, social workers or justice service. The referral is reviewed and contact with the patient made. Emphasis is on self directed therapy. 6 week treatment episode and group work. CBT or counselling can also happen with around 9 sessions treatment carried out.
PH – clients can self refer what about pharmacy – any individual or organisation can refer.
EB – who funds self referral – initial contact made and appropriate signposting made.
NHS number is required to verify a patient is eligible for NHS services. GP may be contacted.
Issue of self referral is the service have limited information, only what the individual gives to the team. Crisis teams.
Christina joined the meeting – MM pre-reg
ACTION: Signposting document to be sent out by SH for all contact with Psychological Therapies.
EPS:
Les Fawcett joined the meeting.
Introductions. BF, PP, JB and SH have been part of the focus group with the CCG and NECS.
NECS delivering EPS project on behalf of Hartlepool and Stockton CCG.
This has been a very quick project. We have met the national targets for lead in times. Schedule has been sent out. Hartlepool area has been chosen first because 97% of all scripts are dispensed within the area. There are Bank House and Headlands that have not got systems to roll this out in the first instance.
McKenzie House is in the middle of migration, they will roll out in second wave. Hart are also in the transition phase. All other practices are going live 17th Feb – 7th March.
Area Team have responsibility for SMART Cards. If timings of support is too limited to contact AT requesting additional support.
03005550340 for new smart card orders.
SR: any progress on cross store dispensers accessing one smart card rather than 18 plus separate applications. To contact order number and put specific cases.
Workshops are booked today and tomorrow. Packs will be given out one to each pharmacy. No individual pharmacy workshops. National contract states referral back to your system supplier for additional support.
Responsibilities – most sites have declared EPS compliant. One more will be updated next week. Sites will then start to get scripts from 17th. Engagement sessions with practices starting Monday 10th Feb. Try to get pharmacists at GP surgery to outline.
How do we separate the pharmacy and practice as a partnership – each have top site they work with. They will then be invited.
Acute scripts in Guisborough are done face to face not via EPS as the time delay can create issues. A best practice would be as Guisborough with Acute scripts.
There is a website to check the status of a script to determine where it is in the system. N3 connection needed. This is on the EPS newsletter. Exemptions must be added at end of each month.
Website for additional guidance is: Information for both pharmacies and patients. The checklist is also available.
Stockton practices are very keen and the CCG is keen to carry on deploying. Need 8 week deployment time. Stockton needs to roll out with a smaller number of practices per week.
Contact Details of Project Manager: 07720345580
ACTIONS: SH to send roll out plans with minutes. Also the roll out packs to be posted on website and put in Newsletter.
Les Fawcett to send through electronic copies of the pack.
Service Update
From the beginning of April the plan is to run all public health services through pharmoutcomes including smoking which will provide an invoicing module with all clinical information being recorded on Quitmanager.
Virgin Healthcare are moving very slowly forward with Chlamydia test and treat, this has been referred back to the Sexual Health commissioners for driving forward and all are aware of the need for an update training module ?via CPPE.
Healthy Start Vitamins will go live on pharmoutcomes and in specific pharmacies as of 1stApril.
Public Health Campaigns
ACTION: Rebecca Laidler to be contacted as did not attend meeting.
Phillipa Walters and Phil Ray joined the meeting.
Public Health Contract and Outcomes
Outline of the existing system given by Phil Ray. Pharmoutcomes will be utilised as much as possible regarding public health systems and processes.
Sub-group to be collected.
PW overarching public health contract which is standard nationally for all public health providers. Each service specification is then included.
The main contract will be signed by Boots and all providers will be included on that one contract. For each pharmacy the spec for each service is now included for each provider.
2 things to review – is the contract acceptable (there is little movement on the current contract). The detail in terms of the service specs is to be agreed.
This to be agreed and rolled out on 1st April.
PR – exemption that services go to specific providers. Local authorities have agreement to continue with current providers but there has to be justification not to put it out on the open market.
SR – if you have a site named as offering services then they have to deliver all or no services. This is not the case it would be a site by site basis.
PW – self declaration of APL. Reassurance of resilience and completing the service is vital to ensure the contract is adhered to and a qualified competent member of staff must be able to deliver.
Other changes – shift from NHS to local authority If an individual is registered with a GP in the area then this will be moved to an address within the borough. The exception will be risk issues ie needle exchange.
SH has discussed a training passport which would be supported by Public Health Shared Service.
Pharmoutcomes will make huge changes to the paper based system.
2 issues regarding subutex and suboxone – the thinking is that subutex and bupropion whether generic or not will be crushed, if the client refuses to have it written on at the treatment provider end of the pathway then it will not be. If it states crushed on a script consent has been provided by the treatment provider. Suboxone will be added into the specification as this is on occasion prescribed. Suboxone will not be crushed. Suboxone should be an exceptional treatment.
New payment structure if supervised less than 3 days a week. There could be more of an increase in costs for local authority, therefore, will need to be discussed in the focus group.
Needle exchange – hep b vaccine was historically provided by the commissioner, this will be absent in the new contract. This should be the responsibility of the employer/provider.
Data entry for pharmoutcomes would need to be negotiated as may take more time.
Stop smoking – new changes will be included. All providers must be able to use quit manager. Plan to introduce 1st April. Pharmoutcomes will be a back up system.
Baby clear baby initiative. Forms have been sent out. Midwives have been involved to reduce smoking in pregnancy. Dispensing only pathway was written into original specification. Tier 3 Stockton and Hartlepool will pilot. Hartlepool all midwives prescribe in Stockton they do not. This will be a model of dispensing only provision. There are now 1 week and 2 week vouchers which are orange – an individual who is not a specialist stop smoking advisor will do a consultation then give a one week voucher. The person with the voucher and a notification of treatment form will be presented. The pharmacy take clinical responsibility to dispense and accept clinical responsibility. For a dispensing only voucher a £10 clinical cheque fee will be paid which means the pharmacist takes clinical responsibility to check the voucher with the individual prior to dispensing. For each of the 4 vouchers there will be £2.50 dispensing fee will be paid also. However, the individual should attend the same pharmacy for each visit. Introduction from midwife via telephone to book an appointment with the lady. You are then guaranteeing a qualified person can then do the clinical check. The midwife does intensive 4 week visits to the person’s home. They will then refer at 4 weeks to the 8 week voucher system. The dispensing fee will be give in association with the voucher, the person as a quitter at 12 weeks will the accrue the 12 week quitter fee. Pharmacy will do CO validation and part of this payment will also go to the pharmacy. In order to claim this PW will provide an additional form to fill in and send in for invoicing. Existing Tier 3 process remains the same. New baby clear voucher will be blue.
ACTION: PW will send out new claim forms. SH to formulate invoice system for Baby clear on PharmOutcomes.
Potentially a PGD for Varenicline will also be formulated as a Tier 4 service. This will include some consent questions. Buprenorphrine will not be included.
Research project in Stockton around weight management in some pharmacies. Expressions of interest have been sent out. 20 were invited. A good response with 10-15 will move forward to pilot the project. This is in collaboration with Stockton Council and Public Health. Small Memorandum of Agreement will be formulated. Payment is around £100 per client. This potentially will give weight to a new specification for weight management. 5th and 19th Feb training.
Paul Pendergood left the meeting to attend the EPS training session
Industry Presentation
Lesley Kennerly McNeil Products.
LUNCH
Healthy Start Vitamins
PW.
90% ready service specification for pharmacies included in the pilot. This will be discussed at contract focus group. Initially it was a way of making available healthy start vitamin products. The Directors of Public Health have now decided to make this universally available to all pregnant women and young children. This is due to a proportion of families with no eligibility to the vitamins free but have a greater need. 3 pathways have now been designed. Initiation of the voucher will be carried out by the midwife. The woman will take the voucher to the pharmacy who will then register the lady for provision of vitamins. There is a claiming process for those eligible from the DOH. The pharmacy will then create a process for dispensing on a repeat basis the vitamins. There will be 3, 2 monthly visits. Asylum seeking families will have a referral issued by the specialist health visitor. The route for anyone else will be through health visitor or midwife contact. 2 pharmacies will be available will be Boots on the High Street in Stockton for Assylum Seekers with one other spare in the town centre. This has been commissioner access rather than. There will no longer be able to collect from sure start and health centres. There will be a list sent to all with a signposting option for those not using the system. ?process if individual presenting with a script. PW will discuss separate contract information with Lloyds who will distribute. In terms of payment there would be a standard one off payment of £200. Also within the contract but if a threshold of a recommended number the pharmacy could potentially receive an additional payment.
CIRCULATION: 20th March 2014 6.30pm is training at Middlesbrough Teaching and Learning Centre.
PNA – each health and well being board have been instructed to announce a review of the PNA with a programme of activity. This is due for publishing March/April 2015. Core steering group at Tees Valley level. LPC representation was on the group last year but there are sensitivities with this so this should maybe available to the LPN to reduce potential for influence. LPC to potentially coordinate locality needs. What soft intelligence is required to inform the PNA.
?Pharmoutcomes to be used to complete PNA questionnaire.
ACTION: SH - Healthwatch – can we let everyone know that people know who they are and why we should engage.
On Demand Availability of Specialist Medicines and Emergency Eye Scheme
Sue Weatherhead – NECS
Paul Wittingham - NECS Commissioning Manager
Andrew Rowlands - NECS Contract Manager
Contracts. Old commissioning 4 PCTs commissioned enhanced services. HAST and ST CCGs now are two commissioning bodies. NECS provide commissioning support on behalf of the CCGs. The DOH published notification that all LES would not be available to be contracted from April 2014 in Pharmacy. All contracts have been reviewed. GPs are only responsible for Fragmin, On Demand Specialist Drugs and Emergency Eye Scheme. Review only of these three services.
Moving forward there needed to be notice by end of December. Notice letter issued end December to cease 31st March. Early Jan letter re continuation of the services. Anything commissioned needs to be on a standard NHS contract. Those specifications that had to continue will be shared end of Feb with all contractors currently providing the service and all who wish to offer the service will then be invited to apply to continue, this will be based on needs of the localities.
On demand scheme has been agreed to continue. Specs will be shared with LPC.
Some additional pharmacies will be included. Some revisions to stock list has also been carried out. Transfer of existing spec on template has been carried out. Emergency Eye scheme – Middlesbrough will be decommissioned. Potential to redevelop an alternative option in the future. Stockton will continue the service.
Payments for out of date was historically made end of year. This will continue and new drug inclusions will be paid up front. There is a £25 historical retainer/professional fee. What is reasonable as a fee.
Communication to all contractors and GPs to be formulated to inform of which pharmacies stock which products.
Question from South Tees CCG – Vitamin K injections. Should be included on the scheme, all agreed.
South Tees want Enoxaparin on DVT pathway. North will not be including.
ACTION: ?pharmacy could record presentations referred on for red eye issues.
ACTION: NECS to send SH copies of the contract information, specs and letters.
LPN Update
MM – There needs to be some large scale communication on the community pharmacy offerings. Directory of services would be useful. MM agreed to pilot in a compact area. All information to be given to hospital pharmacy with regards to referral out. Please refer into the pharmacy. ?to be uploaded onto intranet in hospitals.
ACTION: SH to send up to date list to Philip Dean and copy MM into email.
Stockton Borough Council Compliance aids – must be used only for the benefit for the patient. Individual circumstances must be reviewed at the time. The concern is that certain care organisations determine that care staff must have medipacks. The view that no responsibility to pop a pack and give to the individual is incorrect and should be challenged. The self care route and personal responsibility remains the focus for medicines delivery.